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Team climate and attributes of primary healthcare (PHC) are key elements for collaborative practice. Few researchers have explored the relationship between team climate and patients' perceptions of PHC. This study aimed to assess the association between team climate and patients' perceptions of primary healthcare attributes. A quantitative approach was adopted. In Stage 1, Team climate was assessed using Team Climate Inventory in 118 Family Health Strategy (FHS) teams at a PHC setting. In Stage 2, Patients' perceptions of PHC attributes were assessed using the Primary Care Assessment Tool (PCATool) in a sample of 844 patients enrolled in teams studied in Stage 1. Cluster analysis was used to identify team climate groups. The analysis used multilevel linear regression models. Patients assigned to teams with the highest team climate scores had the highest PHC attributes scores. Patients who reported affiliation at the team level had the highest PCATool scores overall. They also scored higher on the attributes of comprehensiveness and coordinated care compared to patients with affiliation to the health unit. In conclusion, patients under the care of FHS teams exhibiting a more favorable team climate had more positive patient perceptions of PHC attributes. [ABSTRACT FROM AUTHOR]

Screening for depression may identify persons for HIV prevention services and to ensure linkage to care for ART and mental health. We assessed factors associated with depressive symptoms using multiple logistic regression among 15- to 29-year-old gay, bisexual or other men who have sex with men (MSM) and transgender women who have sex with men (TGW) attending HIV prevention clinics at Silom Community Clinic or Bangrak Hospital in Bangkok or Rainbow Clinic in Nakhon Sawan, Thailand. We defined depressive symptoms as a self-report of feelings of sadness that impacted daily life in the past one month. Among 192 MSM, 51 TGW, and 11 gender-questioning persons screened: 12.6% met the criteria for depression; 5.9% had new HIV diagnosis. Independently associated factors which increase the risk of depressive symptoms included: studying in a private school (AOR 7.17); experiencing any type of bullying (AOR 2.8); having a partner with HIV (AOR 4.1); and learning about the study from sources other than a friend (AOR 4.2). Given many youths had depressive symptoms, screening for depression and connection to mental health services would be beneficial in sexual health settings to meet the needs of HIV-vulnerable youth. [ABSTRACT FROM AUTHOR]

Gynecological examination has an very place among to maintain women's health. Negative attitudes and anxiety about gynecological examination may affect coming to the examination. In this study, we aimed to determine the effect of online training and counseling on women's attitudes and anxiety toward the gynecological examination. We randomized 100 women participating in the study into experimental and control groups. We concluded that online training and counseling had a positive effect on the attitudes of women in the experimental group toward gynecological examination. Also we determined that online training and counseling reduced women's state anxiety toward gynecological examinations. In this study, we determined that online training and counseling positively improved women's attitudes toward gynecological examination. We also found that online training and counseling reduced women's state anxiety about gynecological examinations. In the literature, most of the studies on gynecological examination have a descriptive design. This study is important since it contributes to scientific knowledge in determining the attitudes and anxiety levels of women that may affect their status of undergoing gynecological examination. [ABSTRACT FROM AUTHOR]

Professionals with lived experience (LE) of mental distress might better understand service users, educate colleagues, and serve as role models. This exploratory quantitative study asked U.S. social work education leaders if they perceive positives and negatives of professionals having LE; what advice they would offer students with LE; and analyzed whether certain experiences influenced responses. Having LE and/or close relationships with people with LE was associated with perceiving positives, which was associated with advising students about using LE to help others. Perceiving negatives was associated with advising about difficulties. Implications are offered for preparing professionals to use LE in practice. [ABSTRACT FROM AUTHOR]

This study aimed to assess the effect of individualized enteral nutrition management based on the prognostic nutrition index (PNI) on surgical patients with oral malignancies. This quasi-experimental pilot study consecutively included patients diagnosed with oral malignancies who underwent radical surgery in Ningbo No. 2 Hospital between January 2020 and May 2023. The primary outcome was PNI. A total of 71 patients with oral malignancies were enrolled, and 35 patients received PNI-based individualized enteral nutrition management. The PNI group displayed significantly higher PNI than the routine enteral nutrition support group (1st week postoperatively: 39.86 ± 3.86 vs. 37.29 ± 4.23, p < 0.001. 2nd weeks postoperatively: 44.17 ± 4.36 vs. 40.72 ± 3.40, p < 0.001). The surgical suture removal time and length of hospital stay (both p < 0.001) in the PNI group were significantly shorter than in the routine enteral nutrition support group. At 1 month postoperatively, the PNI group had significantly higher scores of QoL (p = 0.002) than the routine enteral nutrition support group. The individualized enteral nutrition management based on the PNI could improve the nutritional status of postoperative patients with oral malignancy, which could facilitate postoperative rehabilitation and improve overall QoL. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the additional effects of perioperative immunonutrition (IMN) compared with preoperative immunonutrition (IMN) on anthropometric, nutritional, and biochemical parameters, hospital stay and postoperative complications in patients with colorectal cancer. Oral supplementation enriched with arginine, omega-3 fatty acids, and dietary nucleotides was given to 25 patients before and after the operation (Group 2); 25 patients received the same formula before surgery and standard isocaloric nutrition following the operation (Group 1). Postoperative body weight, body mass index (BMI), and middle upper arm circumference (MUAC) of Group 1 decreased more than Group 2 during follow-up (p < 0.05). The biochemical parameters, C-reactive protein (CRP), aspartate aminotransferase (AST) and fasting plasma glucose (FPG) were higher, and albumin was lower than the baseline in Group 1 compared to Group 2 (p < 0.05). There was a negative correlation between CRP and Nutrition Risk Screening (NRS) 2002 scores, and prealbumin and NRS 2002 scores had a positive correlation (p = 0.007, r = 0.384; p = 0.012, r = 0.352). There was no difference in hospital stay and postoperative complications between the groups (p > 0.05). Perioperative immunonutrition, compared to preoperative immunonutrition, can be used as a positive and effective approach in improving some anthropometric measurements and biochemical parameters in patients undergoing colorectal cancer surgery. [ABSTRACT FROM AUTHOR]

A 2023 nationwide study of 386 Iranian married heterosexual men assessed compulsive sexual behavior disorder (CSBD) and its correlation with demographic, sexual, and mental health variables. Using the cut-off point ≥ 18 of CSBD Scale-7, 5.2% were CSBD+. Univariate analysis revealed that CSBD+ men had higher rates of substance abuse, pornography use, paraphilic behaviors, sexual desire, arousal, orgasm ability, and younger age at first sex. After Bonferroni correction (p < 0.005), paraphilic behaviors and orgasm ability remained significant. Regression analysis showed positive associations between CSBD and lower age, substance use, extramarital affairs, paraphilic behaviors, higher sex drive, and less orgasm satisfaction. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine sexting behavior, specifically the prevalence of sexting, and its relationships with sociodemographic characteristics (i.e. gender, sexual orientation, and age) and psychological adjustment. To this end, a cross-sectional study was conducted using an online survey. The sample consisted of 999 young adults (98% Italian, 76% female, 67.4% heterosexual) with a mean age of 24.47 years (SD = 3.11). Results showed differences in sexting behavior according to gender and sexual orientation. Age was also associated with sexting behavior. These findings have important implications for clinical practice and future research. Awareness of sexting behavior and its relationships with sociodemographic characteristics can inform the development of targeted interventions to promote safe and ethical use of digital technologies in the realm of sexuality. Additionally, further research can delve into the psychological dynamics involved in sexting and identify risk and protective factors associated with its use. [ABSTRACT FROM AUTHOR]

The study aimed to compare the effectiveness of a traditional cardiac rehabilitation (CR) program with an enhanced program incorporating the model of therapeutic engagement (MTE) and extended remote support for patients undergoing coronary artery bypass graft (CABG) patients. In a randomized controlled trial, 88 CABG patients were assigned to experimental and control groups. The experimental group received integrated MTE cardiac rehabilitation, and assessments were conducted at three time points: pre-CR, one month later, and three months post-CR. The study measured medication adherence (MARS-5) and sense of coherence (SoC-13) scales. The study found no significant differences in demographic factors between the experimental and control groups. However, significant differences were observed in MARS and individuals' SoC scores over time in the experimental group, with notable improvements (p < 0.001). The control group showed significant changes only up to one month. Group effects were evident, with consistent increases in the experimental group's outcomes at each assessment point. Integrating the MTE into CR programs offers benefits in terms of medication adherence and individuals' sense of coherence, which warrants further investigation and clinical implementation. Cardiac rehabilitation (CR) is recognized as one of the most effective interventions for secondary prevention, but its accessibility is limited in middle-income countries (MICs). This study represents one of the first theoretically-informed CR trials in a MIC that incorporates the model of therapeutic engagement (MTE) combined with extended remote support services into CR program. The MTE model, as a theoretical framework, was highly suitable for CR settings and demonstrated favorable outcomes. This approach has the potential to greatly benefit cardiac patients, particularly those who may initially show hesitance or reluctance towards engaging in CR. [ABSTRACT FROM AUTHOR]

Librarians' involvement in Evidence-Based Medical Practice (EBMP) has been widely reported from the Global North. The cross-sectional study designed a survey to investigate how African medical librarians integrate into EBMP. The respondents comprised medical librarians from 12 African countries. Findings revealed that African medical librarians are mostly involved in EBMP activities related to resource use, management, and evidence dissemination. The leading EBMP tools reportedly used or promoted by the librarians include UpToDate and Cochrane Library, while the leading challenges encountered in offering support for EBMP are related to skill deficiency, poor funding, and poor internet connectivity. [ABSTRACT FROM AUTHOR]

We aimed to compare outcomes including seizure-free status at the last follow-up in adult patients with medically refractory focal epilepsy identified as lesional vs. non-lesional based on their magnetic resonance imaging (MRI) findings who underwent invasive evaluation followed by subsequent resection or thermal ablation (LiTT). We identified 88 adult patients who underwent intracranial monitoring between 2014 and 2021. Of those, 40 received resection or LiTT, and they were dichotomized based on MRI findings, as lesional (N = 28) and non-lesional (N = 12). Patient demographics, seizure characteristics, non-invasive interventions, intracranial monitoring, and surgical variables were compared between the groups. Postsurgical seizure outcome at the last follow-up was rated according to the Engel classification, and postoperative seizure freedom was determined by Kaplan-Meyer survival analysis. Statistical analyses employed Fisher's exact test to compare categorical variables, while a t-test was used for continuous variables. There were no differences in baseline characteristics between groups except for more often noted PET abnormality in the lesional group (p = 0.0003). 64% of the lesional group and 57% of the non-lesional group received surgical resection or LiTT (p = 0.78). At the last follow-up, 78.5% of the patients with lesional MRI findings achieved Engel I outcomes compared to 66.7% of non-lesional patients (p = 0.45). Kaplan-Meier curves did not show a significant difference in seizure-free duration between both groups after surgical intervention (p = 0.49). In our sample, the absence of lesion on brain MRI was not associated with worse seizure outcomes in adult patients who underwent invasive intracranial monitoring followed by resection or thermal ablation. [ABSTRACT FROM AUTHOR]

The medical information about anemia prevention produced by health-care professionals is difficult to understand because of its complicated terminology. To evaluate quantitatively for the first time the clarity of existing online information about anemia prevention in Japanese. On January 20, 2023, we used the keyword "anemia" to evaluate 200 websites, followed by use of the Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P) and the Clear Communication Index (CCI) to evaluate understandability and actionability. The PEMAT-P and CCI were both evaluated as excellent in terms of understandability and actionability, with cutoff values of 70% or higher and 90% or higher, respectively. We also evaluated readability using jReadability and quality using the Journal of the American Medical Association (JAMA) Benchmark Criteria and The Global Quality Scale (GQS). The PEMAT-P scores for understandability and actionability exceeded the cutoff value in 59 (29.5%) and 36 cases (18.0%), respectively, while the CCI exceeded the cutoff value in two cases (1.0%). With respect to web pages, nine (4.5%) were considered "readable" and 96 (48.0%) "neutral." These findings suggest that websites on anemia in Japanese have poor "understandability," "actionability," and "readability," and are therefore inaccessible to the general public. Improving existing anemia websites using indicators such as the PEMAT-P could improve behaviors related to anemia prevention. [ABSTRACT FROM AUTHOR]

Māori adolescents are more likely to have lived through an array of adverse experiences due to unequal exposure to social disadvantage that Indigenous Māori face in Aotearoa New Zealand. Most of this disadvantage arises from intergenerational inequity resulting from the British colonial process. This study aimed to investigate how disadvantage manifests in the backgrounds of Māori adolescents with harmful sexual behaviours. Background characteristics in a sample of 1024 males (aged between 12 and 17), who were referred to a treatment programme for harmful sexual behaviour, were analysed and comparisons made between Māori and non-Māori on risk factors. Māori exhibited higher rates of risk factors (substance abuse, familial criminality, physical abuse victimisation and family violence) at different contextual levels (i.e. individual, family, school). Risks of school exclusion and sexual abuse victimisation were similar across ethnicities. Recommendations are made for prevention/treatment efforts that use holistic and culturally informed approaches. Culturally appropriate treatment for Māori with harmful sexual behaviours (HSBs) is recommended. This needs to be led by Māori, for Māori and with Māori, including whānau/family-based treatment and prevention. [ABSTRACT FROM AUTHOR]

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This study aimed to adapt a Spanish translation of the Oswestry Disability Index (ODI) into a cross-cultural version for the Mexican population. The objectives were to verify the validity and reliability of the adapted ODI and to compare pain perception between patients with and without obesity. We included 102 patients with low back pain from two neurosurgery departments in Mexico. The ODI questionnaire was translated and culturally adapted. Validity and construct were evaluated using exploratory factor analysis, and the external convergent validity was assessed by correlating ODI scores with pain intensity, age, and obesity. Test-retest reliability was calculated using the intraclass correlation coefficient, and confirmatory analysis was employed to validate the factorial structure. Patients with obesity were older and had higher pain scores than patients without obesity. The exploratory analysis of the ODI in Mexican Spanish showed good reliability (Cronbach's alpha of 0.923) and validity (factorial loading range, 0.681 − 0.818). The confirmatory analysis showed almost null or very low discrepancy between the proposed model and the real data. A Spanish translation of ODI was cross-culturally adapted for the Mexican population. The Mexican version of the ODI showed good reliability and validity in Mexican culture. The Oswestry Disability Index (ODI) is a widely used tool to measure physical disability in daily activities due to low back pain. A Spanish-language version has not been culturally adapted and validated for Mexican habits and lifestyle. This study describes the process of the Spanish ODI translation and cultural adaptation, showing it is a reliable and valid tool for assessing disability in patients with low back pain, with a good factorial structure. [ABSTRACT FROM AUTHOR]

Patient activation is associated with treatment adherence, self-accountability for healthcare and a healthy lifestyle change. Mobile health (m-Health) apps can lead to greater patient treatment adherence and health behaviour change. This study aimed to evaluate the health behaviour change of elderly people through a healthcare programme focused on activation with the support of technology. Three phases were conducted: (1) pre-intervention – design of the intervention protocol and the app, (2) intervention – randomised clinical trial with 41 overweight/obese elderly people. m-Health app-supported group psychotherapy was compared with group psychotherapy only and individual psychotherapy (control) and (3) post-intervention – statistical analysis, intervention's assistant interviews and app heuristics evaluation. By crossing the results, the study has shown that there was no significant difference in the activation level before and after intervention between groups. However, there was a significant increase from the initial mean score to the final one when considering the three groups together. Group therapy, whether with or without the support of the app, was more effective for behaviour change measured by the achievement of the goals, than individual psychotherapy. The lack of impact on group therapy with app support calls into question which and how much technology support is useful. [ABSTRACT FROM AUTHOR]

To evaluate the balance in patients with total knee arthroplasty (TKA) and knee osteoarthrosis (KOA), measured by postural stability computerized evaluation (PSCE), and to evaluate the effect of post-TKA patients' characteristics in their performance on PSCE. An observational cross-sectional study was conducted in two sets of patients: (A) patients with KOA and primary TKA surgery scheduled and (B) patients who underwent primary TKA >9 months. Sociodemographic, radiographic, clinical and PSCE parameters (using the Biodex Balance System) were assessed. Post-TKA patients placed more load on the replaced knee than the contralateral osteoarthritic knee (p = 0.027). They had less imbalance on the balance tests performed with the eyes open, on stable (p = 0.032), and unstable platforms (p = 0.022). These patients also showed better postural stability in monopodalic stance, both standing on the TKA (p = 0.010) and contralateral knee (p = 0.017). Age, weight, pain on the operated knee, extension deficit on the operated knee, and Berg Balance Scale scores on post-TKA patients were significantly associated with their performance on PSCE tests. PSCE can be useful to quantify the balance of post-TKA and KOA patients. Total knee arthroplasty is the definitive treatment for knee osteoarthrosis and it has several benefits, but its effect on balance is still unknown. Postural stability computerized evaluation is used to evaluate balance on vestibular diseases and it has been recently studied on musculoskeletal conditions. Postural stability computerized evaluation may be useful to evaluate patients' balance before and after total knee arthroplasty. [ABSTRACT FROM AUTHOR]

Innovation is an organizational learning process that demands a reflexive perspective to take on uncertainties and question deeply held assumptions, propelling leadership and organizational structures forward. Discussions on the relationships between innovation and reflexivity predominantly focus on individuals rather than considering it a shared capability within an organization. This study elucidates the impact of reflexive-learning-based leadership development on promoting collective reflexivity, navigating its implications for organizational leadership and structures in innovation. A reflexive-learning-based leadership development program is a set of collective actions comprising four fundamental steps: acknowledging problems, reassessing assumptions, thinking of alternatives, and developing new perspectives. This study demonstrates its effectiveness in developing collective reflexivity within an engineering organization by repurposing the After-Action Review (AAR) as reflexive learning training. The findings underscore reflexive learning, making leaders exhibit the traits of ambiguity tolerance and interdisciplinary knowledge that favor innovation. This research contributes to an academic framework, opening avenues for future investigations into organizational development from a reflexive perspective and providing a proven managerial practice to improvise an effective solution to overcome those uncertainties in real-world innovations. [ABSTRACT FROM AUTHOR]

To examine whether extended compared to standard level of physiotherapy is feasible and has beneficial effects on physical function in ICU survivors. This prospective pilot study with a before and after design included patients discharged from ICU to a surgical ward. The comparison group were recruited between January and April 2019 and received standard level of physiotherapy. The intervention group were recruited between May and December 2019 and received extended physiotherapy, corresponding to 50% additional physiotherapist, working 4 hours per weekday. The intervention participants received an individual rehabilitation plan developed in collaboration with a ward-based physiotherapist, and an extended number of sessions provided by the extra resource included practicing individualized exercises, for example walking and stair climbing. Physical function was measured with the Chelsea Critical Care Physical Assessment tool (CPAx) at ICU discharge, during hospital stay and discharge. Group differences were analyzed using the Mann–Whitney U-test and Chi2 test. Out of 46 eligible patients, 39 (85%) fulfilled the study (comparison n = 12, intervention n = 27) and were included in the final analyses. No adverse events occurred, and the attendance rate was high (98.5%). There were no statistically significant differences between the groups regarding physical function, hospital stay, and readmissions, but there were tendencies to better outcomes in all these parameters in favor of the intervention group. Additionally, patients in the intervention group had statistically significantly higher scores in the CPAx items "transferring from bed to chair" (median 5 vs 4, p =.039) and "stepping" (median 5 vs 4, p =.005) at hospital discharge. This pilot study indicates that extended physiotherapy after ICU discharge is feasible and does not entail patient safety risks. However, determining the potential beneficial effects for the patients remains to be evaluated in a larger trial. [ABSTRACT FROM AUTHOR]

Coronavirus Disease 2019 (COVID-19) became a significant challenge for the work and personal experience of physiotherapists (PTs) To investigate how the work activities of PTs in a region in Italy have changed, describe the reasons for change, perceived competence, and effectiveness of professional education, and explore their personal experience We adopted a monocentric convergent mixed-methods light–questionnaire variant study. The questionnaire contains both closed-ended and open-ended questions. Quantitative and qualitative data were combined to interpret the results Among 78 respondents (response rate 24.4%), 87.2% worked during the pandemic, 52.9% treated patients with COVID-19, and 45.6% changed their working activities. Professional competence was perceived as low in intensive and sub-intensive care settings. The major critical aspect of professional education was respiratory rehabilitation. Life-learning education was judged as effective, even if mainly focused on safety. Nine themes emerged from the analysis of the PTs' experiences: 1) Physiotherapy during COVID-19; 2) Fear and negative feelings; 3) Positive aspects; 4) Organization and management; 5) Prevention measures; 6) Patients; 7) Change; 8) Information; and 9) Professional education PTs who have direct experience with patients with COVID-19 showed great resilience. They overcame the first phase of disorientation and fear, despite a specific lack of competence in the respiratory field. [ABSTRACT FROM AUTHOR]

The risk of injury in archery is supposedly low. However, relations between pain, shooting phases and types of bow have not been studied. Understanding the biomechanical mechanisms of archery-related injuries. Online survey for archers from all types of bow. Variables were analyzed using contingency tables and chi-squared tests. 396 surveys were completed. 36.9% of the archers had practiced archery for more than 10 years, 23.3% between 5 and 10 years. Olympic recurve bow was the most commonly used (38.2%), followed by traditional (23.3%) and compound (22.0%). 57.3% of the archers suffered some kind of injury during archery practice. Drawing shoulder (28.2%) and neck/back injuries (19.9%) were the most prevalent, preventing 50.3% of those who suffered them from continuing archery practice. There was a moderate association between drawing arm injuries and symptomatology in the drawing phase, especially in the shoulder region (0.55), elbow (0.20), and hand (0.13), and to a lesser extent in the neck/back (0.28). Our results show that injury chronicity is frequent on archery. Correlations between types of bow, phases of the shoot and areas of pain could be a starting point for future studies on the repercussions of different types of injuries in archery practice. [ABSTRACT FROM AUTHOR]

Early cardiac rehabilitation using non-invasive ventilation (NIV) and aerobic exercise may reduce the length of hospital stay in patients with heart failure (HF), however, there is still no evidence of this effect on patients in the intensive care unit (ICU). to investigate the effects of aerobic exercise (AE) performed simultaneously with non-invasive ventilation (NIV) on the length of intensive care stay (LICUS) in patients diagnosed with decompensated heart failure (HF) admitted to the intensive care units (ICU). Twenty-eight patients admitted to the intensive care unit (ICU) because of decompensation of HF were randomised into two groups: the intervention group (AE + NIV), and a control group. The intervention group's treatment strategy involved simultaneous AE with NIV daily. The control group performed non-simultaneous AE and NIV daily during their ICU stay. The primary outcome was LICUS. The secondary outcomes were the length of hospital stay, peripheral and respiratory muscle strength, functional status, functional classification, and exercise tolerance. The mean LICUS was shorter in AE + NIV than in the control group (6.3 ± 4.7 days vs 8.3 ± 3.6 days, respectively; p = 0.015). Secondary outcomes were similar between groups, except for exercise hemodynamics, which was improved in AE + NIV, as showed by the decreased diastolic blood pressure immediately after the exercise tolerance test. The use of AE simultaneous with NIV reduced the LICUS of patients admitted to the ICU because of decompensated HF. This innovative approach is a promising tool for accelerating ICU discharge during the in-hospital rehabilitation of patients with HF. [ABSTRACT FROM AUTHOR]

Without standard guidelines, there is a critical need to examine anal cancer screening uptake in the South which has the highest HIV incidence in the U.S. We identified factors associated with screening among men living with HIV (MLHIV) at a large academic HIV outpatient clinic in Alabama. Relationships between sociodemographic, clinical, sexual risk characteristics and screening were examined using T-tests, Fisher's exact, Chi-square, and logistic regression analyses. Unadjusted and adjusted odds ratios (AOR) were computed to estimate the odds of screening. Among 1,114 men, 52% had received annual anal cytology (pap) screening. Men who were screened were more likely to have multiple sexual partners compared to men who were not screened (22.8% vs. 14.8%, p = 0.002). Among men with one partner, the youngest were almost five times more likely to be screened compared to middle-aged men (AOR = 4.93, 95% CI: 2.34–10.39). Heterosexual men had lower odds and men who reported unprotected anal sex had higher odds of screening. Our findings suggest a racial disparity, with older black MLHIV being the least likely to be screened. In the South, MLHIV who are older, black, heterosexual, or live in high social vulnerability counties may be less likely to receive annual anal cancer screening. [ABSTRACT FROM AUTHOR]

This article describes data on the gender distribution of mental health disorders among adolescents of Togo, West Africa. The sample size of this study included 242 patients. Gender and mental health disorders according to the definition of International Classification of Disease, tenth revision (ICD-10) were considered. Females were significantly more likely to develop a mental health disorder than males (61.16% vs 38.84% of the sample), and females were significantly 3 times more likely to develop Somatoform Disorders- Other Neurotic Disorders compared to males. Males were significantly 2 times more likely to develop Acute and Transient Psychotic Disorders. [ABSTRACT FROM AUTHOR]

To independently validate the negative predictive value of the Tanta University risk model for intensive care requirements in poison center telephone consultations with other physicians. This study included 400 consecutive patients with acute poisoning. Clinical and laboratory parameters were recorded during the initial consultation with the poison center. Patients who were already ventilated or on vasopressors at the time of consultation were excluded. The Tanta University risk model score was calculated from the data according to the following equation: Tanta University risk model score = 1.966*Glasgow Coma Scale + 0.329*oxygen saturation (percent) + 0.212*diastolic blood pressure (mmHg) − 0.27*respiratory rate (breaths/minute) + 0.33*standard bicarbonate (mmol/L). Twenty-four hours later, the patients' courses were followed up by telephone. The Tanta University risk model was then compared to a composite endpoint indicating the requirement for admission to an intensive care unit (vasopressors, need for intubation, or death). Four hundred patients with acute poisoning were included. Thirty-seven patients had a complicated clinical course as defined by the composite endpoint. Receiver operating characteristic analysis revealed the area under the curve to be 0.87 (95 percent confidence interval 0.83–0.90). An unfavorable Tanta University risk model score was defined as less than 73.46, using a cut-off derived from a previous study of an unrelated series of patients with acute poisoning admitted to our service. Thirty-one of 37 patients with complicated courses had an unfavorable Tanta University risk model score compared to six patients with complicated courses among 306 patients with a favorable Tanta University risk model score (P < 0.0002, Fisher's exact test). Sixty-three patients had an unfavorable Tanta University risk model score but an uneventful course. The negative predictive value of the Tanta University risk model was 0.98 (95 percent confidence interval 0.96–0.99), sensitivity was 0.84, and specificity 0.83. In the present study of poison center telephone consultations, the Tanta University risk model was significantly related to the outcomes in patients with acute poisoning. Patients with a favorable Tanta University risk model score (greater than or equal to 73.46) were unlikely to need intensive care unit level of care. [ABSTRACT FROM AUTHOR]

Objective: To evaluate requests for legal abortion due to pregnancies resulting from sexual violence (SV) in a reference service, and characterise and compare the outcome groups. Retrospective cohort study with review of medical records of women assisted between 2015 and 2020. The variables were socio-demographic and SV characteristics, gestational age, reactions towards pregnancy and outcome. We compared outcome groups using the chi-square test, Fisher's exact test and the Kruskal–Wallis test. The significance level was 5%. We evaluated the medical records of 235 women, of which 153(65%) had undergone to abortion; 17(7.2%) had a spontaneous abortion; 19(8%) remained pregnant; 25(10.6%) had an abortion denied; and 21(8.9%) had been lost to follow-up. Out of the total number of women, 44(18.7%) were adolescents, 152(65.2%) were white and 201(88.5%) had an education ≥9 years. Women who remained pregnant had a known aggressor, disclosed the pregnancy (p < 0.001) and were more ambivalent (p < 0.001) than the other groups. Gestational age was higher in the denied abortion group than in the performed abortion group (p < 0.001). Feelings related to decision-making about abortion affected all groups, with differences. It is important to give women space to be heard, so they can make their own decisions. Abortion care is possible in places with restrictive laws; however, women with more vulnerable characteristics did not seek the service. Legal restrictions interfere with women's decision-making about abortion and can promote inequality in gaining access to health services. [ABSTRACT FROM AUTHOR]

This study was designed to evaluate the effect of selenium supplementation in inactive moderate-severe Graves' orbitopathy (GO) patients. This study was a single-center, placebo-controlled, double-masked, randomized trial. Inactive moderate-severe GO participants were randomized to receive six months of 200 micrograms/day of selenium supplementation or placebo. Thorough eye exams, clinical activity score (CAS), Graves' Ophthalmopathy quality of life questionnaire (GO-QOL), and serum selenium level were evaluated at baseline and 6 months after the interventions. The chi-squared or Fisher's exact test was used to compare categorical variables. The t-test and the paired t-test were used to compare continuous variables between two independent samples and two dependent samples, respectively. A total of 25 participants were enrolled, 13 in the selenium group and 12 in the placebo group. Both groups had adequate baseline serum selenium levels at 98.96 ± 15.63 mcg/L and 102.55 ± 17.71 mcg/L, respectively. After 6 months of intervention, the selenium group showed a greater improvement in palpebral aperture (mean difference: −1.4 ± 1.7 mm, p =.04) compared to the placebo group (−0.3 ± 2.7 mm). Notably, 5(41.67%) people in the placebo group developed larger palpebral apertures. Proptosis, ocular motility, and soft tissue signs did not change significantly. GO-QOL and CAS score improvement showed no statistically significant difference between both groups. Minor adverse effects were observed. Selenium supplementation has a positive effect on eyelid aperture even in inactive moderate-to-severe GO patients with a sufficient baseline selenium level. [ABSTRACT FROM AUTHOR]

Astragaloside IV (AST) has been confirmed to have antiasthmatic effects. However, the underline mechanism is unclear. The study aimed to explore the treatment mechanism of AST based on autophagy of memory T cells. AST treatment significantly decreased the number of T effector cells in asthma mice blood and the nude mice that received AST-treated TCMs had relieved inflammation compared with the untreated group; meanwhile, we found that AST significantly decreased the autophagy level and inhibited OX40/OX40L signal pathway of lymphocytes. The results highlighted that AST regulated autophagy to inhibit differentiation of effector T-cell phenotype. [ABSTRACT FROM AUTHOR]

Trunk muscles' function and characteristics are of great importance for both static and dynamic tasks in different sports, and abnormalities of trunk flexors and extensors might be associated with low back pain (LBP). The aim of this study was to provide a comprehensive evaluation of the functional, morphological and contractile properties in trunk flexors and extensors of young gymnasts with and without LBP. Young gymnasts (14/25 females, 14–18 y) were screened for the presence of chronic LBP. Abdominal and lumbar muscles were tested for function (McGill's endurance tests), thickness (ultrasound), and contractile responses (tensiomyography). An 8-sessions physiotherapy intervention including postural reeducation was performed by a subsample of 10 subjects with LBP. LBP was found to be associated to higher flexors-to-extensors endurance ratio (OR 11.250, 95% CI: 1.647–76.849, p = 0.014), reduced mean lumbar multifidus thickness (OR 16.500, 95% CI: 2.246–121.228, p = 0.006), and reduced mean erector spinae radial displacement (OR 16.500, 95% CI: 2.246–121.228, p = 0.006). The physiotherapy intervention was found to reduce LBP symptoms and it was associated with a significant improvement in the flexors-to-extensors ratio (p < 0.001). This study provides preliminary evidence of functional, morphological, and contractile trunk muscles' alterations associated with chronic LBP in young gymnasts, and presents the effects of a postural reeducation program on symptoms and muscles' functional properties. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the effects of exercises by mechanical hippotherapy devices on postural control, balance, mobility, and Quality of Life in patients with stroke. This was a randomized controlled clinical trial with a total of 30 which were randomly divided into two groups. The participants in the mechanical hippotherapy group (MHG) (n = 15) were given exercises with a mechanical hippotherapy device for 15 min in addition to intensive conventional treatments (45 min), while the control group (CG) (n = 15) received additional 15 min of postural control and balance exercises for five days per week for four consecutive weeks. The primary outcome was The Berg Balance Scale (BBS). Secondary outcomes were the Fugl–Meyer (FM) Rating Scale, Biodex Balance Measurement (BBM), Trunk Impairment Scale (TIS), the Timed Up and Go Test (TUG) and quality of Life Short Form (SF-36). In the MHG, FM-Lower extremity score (−6.4, p = 0.024), FM-Upper extremity score (−12.87, p = 0.013), TIS (−5.87, p = 0.04) and TUG (5.73, p = 0.027) improved statistically significant compared to CG. Exercises using mechanical hippotherapy devices could improve postural control, functional mobility and balance in patients with stroke. It may also improve the quality of life. NCT03528993 NCT03528993 It was concluded from our results that mechanical hippotherapy could be included in the treatment programs of stroke patients. [ABSTRACT FROM AUTHOR]

Pelvic fractures resulting from high-energy trauma can frequently present with life-threatening hemodynamic instability that is associated with high mortality rates. The role of pelvic exsanguination in causing hemorrhagic shock is unclear, as associated injuries frequently accompany pelvic fractures. This study aims to compare the incidence of hemorrhagic shock and in-hospital outcomes in patients with isolated and non-isolated pelvic fractures. Registries-based study of trauma patients hospitalized following pelvic fractures. Data from 1997 to 2021 were cross-referenced between the Israel Defense Forces Trauma Registry (IDF-TR), documenting prehospital care, and Israel National Trauma Registry (INTR) recording hospitalization data. Patients with isolated pelvic fractures were defined as having an Abbreviated Injury Scale (AIS) <3 in other anatomical regions, and compared with patients sustaining pelvic fracture and at least one associated injury (AIS ≥ 3). Signs of profound shock upon emergency department (ED) arrival were defined as either a systolic blood pressure <90 mmHg and/or a heart rate >130 beats per min. Overall, 244 hospitalized trauma patients with pelvic fractures were included, most of whom were males (84.4%) with a median age of 21 years. The most common injury mechanisms were motor vehicle collisions (64.8%), falls from height (13.1%) and gunshot wounds (11.5%). Of these, 68 (27.9%) patients sustained isolated pelvic fractures. In patients with non-isolated fractures, the most common regions with a severe associated injury were the thorax and abdomen. Signs of shock were recorded for 50 (20.5%) patients upon ED arrival, but only four of these had isolated pelvic fractures. In-hospital mortality occurred among 18 (7.4%) patients, all with non-isolated fractures. In young patients with pelvic fractures, severe associated injuries were common, but isolated pelvic fractures rarely presented with profound shock upon arrival. Prehospital management protocols for pelvic fractures should prioritize prompt evacuation and resuscitative measures aimed at addressing associated injuries. [ABSTRACT FROM AUTHOR]

Identifying factors influencing the retention in the treatment of substance users is one of the great issues in the health field. The present study was performed to identify the motivations to start treatment and their relationship with retention in the treatment. This cross-sectional study carried out on 189 people with substance use disorder undergoing treatment in the first month referred to addiction treatment clinics in 2021. Forty clinics were selected using a simple random sampling method. Required information was collected using a demographic and "motivating factors to quit" questionnaire. Data were analyzed using chi-square, Fisher's exact and Mann – Whitney U tests through SPSS version 24. This study showed a significant relationship between the place of residence and occupation of the subjects with all the fields of the "motivating factors to quit" questionnaire (p < 0.05). Only "family" item had a significant relationship with retention in the treatment (p < 0.05). Considering the relationship between the family item and retention in the treatment, it seems that informing the patient's family about the importance of encouraging, supporting and quit plan can be an effective help in increasing retention in the treatment. [ABSTRACT FROM AUTHOR]

Tobacco smoking and substance use is a public health hazard. The investigations studying tobacco smoking, substance use, and their associated factors among Iraqi undergraduates are limited. Our study aimed to examine tobacco smoking, and substance use among medical undergraduates in Najaf, Iraq, and report associated characteristics. A piloted questionnaire was utilized to conduct a descriptive cross-sectional web-based survey. The snowball technique was used for sampling. The subjects' features, perceived risk of harm, location, motivations, and effects of cigarette smoking and substance misuse were used to conduct association testing. Tobacco smoking was reported in 17.3% of the students (at least once in the previous month), and substance use in 3%. Mostly, the age of initiation was <15 years, and psychological stress (50.9%) was the reason for tobacco smoking and substance use. However, the presence of a smoker or user friend or family member was significantly associated (p-value <.05) with tobacco smoking and substance use. The prevalence of tobacco smoking and substance use and several risk factors were identified. In addition to promoting awareness about tobacco smoking and substance use and its potential consequences, the associated characteristics reported in this study are useful when developing effective counteracting policy initiatives. [ABSTRACT FROM AUTHOR]

The "Eye Movement Desensitisation and Reprocessing" (EMDR) is a therapy targeting traumatic memories. Although memories from their substance use memory may increase the risk of relapse, only a few studies investigated the effects of EMDR in addiction. Individuals with substance use disorders (SUD) receiving TAU in a residential setting were randomized for EMDR in conjunction with TAU (EMDR + TAU) and TAU groups. Craving for the substance, substance target memory features, relapse rates and other measures of EMDR efficacy were assessed after intervention at 6 weeks (T1) and 6-month follow-up (T2). EMDR + TAU significantly suppressed substance craving, pleasantness, and target memory vividness at T1, but increased substance unpleasant scores. EMDR effects were also significantly observed at T2 for pleasantness and vividness. EMDR + TAU group showed high scores and reported benefits from EMDR, but not significant differences in relapse rate, vs. TAU group. Our study suggests that EMDR + TAU in SUD inpatient in a residential setting may reduce substance craving, and in the meantime, provides proof-of-concept on targeting substance memory. [ABSTRACT FROM AUTHOR]

Adolescents with chronic illnesses face unparalleled challenges. To better understand these challenges and their impact on mental well-being, the Strengths and Difficulties Questionnaire Dysregulation Profile (SDQ-DP) was employed as a clinical assessment tool. The primary aim of our cross-sectional study conducted at a tertiary care center was to assess the prevalence of high SDQ-DP scores and its association with depressive symptoms, suicidal behaviors, and health-related quality of life (HRQoL) among adolescents aged 10–18 years diagnosed with various chronic illnesses. Among the 130 participants, 11.5% exhibited high SDQ-DP scores. Adolescents with high SDQ-DP scores displayed significantly higher rates of depression (aOR 12.37, 95% CI 2.15–71.19), suicidal ideation (aOR 18.68, 95%CI 2.72–128.33), suicidal plan (aOR 23.02, 95%CI 3.48–152.24), suicidal attempt (aOR 25.48, 95%CI 2.83–229.17) and diminished HRQoL (p < 0.001). This study has supported the correlation between high SDQ-DP scores and compromised mental well-being, highlighting the tool's clinical significance. [ABSTRACT FROM AUTHOR]

Orthotic devices may be prescribed for the management of foot and ankle deformities caused by Charcot-Marie-Tooth disease (CMT). However, the actual use of these devices is variable. No studies have evaluated the impact of prescription, delivery and follow-up of orthotic devices on their use. We aimed to describe the relationship between the pathways followed by individuals with CMT and orthotic device use. Exploratory, cross-sectional, 35-item survey of orthotic device management. Individuals with CMT were recruited from CMT-France Association. Of the 940 respondents, 795 were included, mean age of 52.9 (SD 16.9) years. Rate of orthotic device use was 49.2% (391/795). The most frequent reason for non-use was a poor fit. Non-use was related to the orthotic device type, the health professionals consulted, and the severity of the CMT-related impairments. Follow-up visits (38.7%), re-evaluation of orthotic devices (25.3%) and consultations with the Physical and Rehabilitation Medicine physician were infrequent (28.3%). Orthotic devices are massively underused. Follow-up and re-evaluation are infrequent. Care pathways, prescription and delivery of orthotic devices must be optimized to meet the expectations of people with CMT. Device fitting, individual needs, and changes in the clinical state must be re-evaluated regularly by specialists to improve orthotic device use. Foot deformities and foot drop contribute to disability in people with Charcot Marie Tooth Disease but use of orthotic devices is poor. To improve orthotic device use, regular multidisciplinary consultations and regular re-evaluation of the device by specialists in neuro-orthopaedics are important. The device fit should be regularly re-evaluated by the prescribing doctor or the practitioner who made the device. Regular multimodal evaluation of foot deformity, including muscle strength and length, and the individual's needs and expectations is also important to improve orthotic device use. [ABSTRACT FROM AUTHOR]

Patients with systemic sclerosis (SSc) are at high risk for pulmonary and vascular complications. Smoking is an important risk factor for respiratory symptoms and vascular complications of many diseases in the general population. However, studies on the role of smoking in SSc are insufficient. This study aimed to compare pulmonary function, respiratory symptoms, functional level, and health-related quality of life (HRQoL) in patients with SSc according to smoking status and to assess the correlation between cigarette consumption and these parameters in patients with SSc. Seventy-two patients with SSc (smoker group; n = 35 or nonsmoker group; n = 37) were included. The pulmonary function test was measured with a spirometer. Respiratory symptoms were questioned and the perceived severity of dyspnea and fatigue was evaluated. The functional levels were determined by questioning the patients' average daily walking distance, exercise habits, and daily sedentary time. HRQoL was assessed by Scleroderma Health Assessment Questionnaire. The rate of respiratory symptoms including dyspnea, cough, and sputum were higher in the smoker group (p<.001, p =.041, and p<.001, respectively). Also, the perceived severity of dyspnea and fatigue was higher in the smoker group (p <.05). The mean daily walking distance, exercise habits, and overall HRQoL were lower (p =.004, p =.002, and p =.034, respectively) and the sedentary time and vascular complications were higher (p<.001 and p =.038, respectively) in the smoker group. However, there was no significant difference between the two groups in terms of the pulmonary function test (p >.05). There was a weak to moderate correlation between cigarette consumption and respiratory symptoms, dyspnea and fatigue severity, functional level, and HRQoL in the smoker group (0.001 ≤ p ≤.024). Smoking may increase respiratory symptoms and vascular complications and decrease the functional level and HRQoL in patients with SSc. To maintain functional independence in patients with SSc, awareness of the harms of smoking should be increased and smoking cessation should be encouraged, along with physiotherapy and rehabilitation programs including exercise and physical activity recommendations. [ABSTRACT FROM AUTHOR]

Elderly individuals with neurodegenerative diseases, such as Parkinson's disease (PD), may experience difficulties when performing functional tasks. To analyze the handgrip strength, pulling force, and ground reaction forces (GRF) of individuals with and without PD when boarding a bus while performing both simple (ST) and dual tasks (DT). This case-control study addressed 31 individuals with PD (GPD) and 30 healthy individuals (GHI). Assessments were performed in ST and DT situations using a bus model (prototype). Handgrip strength and pulling force were measured in both upper limbs using a dynamometer, and GRF was measured using a force platform. The GPD's and GHI's performances were compared in both ST and DT, and the individuals were classified as fallers according to the Falls Efficacy Scale. In the inter-group comparison, the GPD presented significantly lower maximum force using their right hand, in handgrip strength (30.43 vs. 36.62, P =.022), and pulling force (10.77 vs 12.81, P =.037). The left hand's pulling force proved to be the most demanding for the GPD, during ST (6.35 vs. 4.76, P =.006) and DT (6.32 vs 4.74, P =.008). The GPD also took longer to perform ST (6.14 vs. 4.67, P <.001) and DT (6.08 vs. 4.81, P =.002). Additionally, the GPD was more afraid of falling compared to the GHI (34.74 vs. 24.77, P <.001). Boarding a bus is a complex task for individuals with PD because they present lower maximum strength in the upper limbs and more significant functional expenditure than their healthy counterparts. [ABSTRACT FROM AUTHOR]

The Human Immunodeficiency Virus (HIV) epidemic remains a major public health issue worldwide. In Vietnam, the HIV epidemic is essentially driven by people who inject drugs (PWID). This study aims to compare mortality and loss to follow-up (LTFU) between PWID and other patients. From June 2017 to April 2018, HIV-infected adults were enrolled in a prospective cohort from time of ART initiation in six provinces of North Vietnam. The end date was July 2020. Mortality and LTFU were described using competing-risk survival models. Factors associated with mortality and with LTFU were identified using Cox models with a competing-risk approach. Of the 578 participants, 261 (45.2%) were PWID and almost exclusively male. 49 patients died, corresponding to a mortality rate (95% confidence interval (CI)) of 3.7 (2.8–4.9) per 100 person-months, and 79 were lost to follow-up, corresponding to a rate (95% CI) of 6.0 (4.8–7.4) per 100 person-months. PWID were at higher risk of death but not of LTFU. Overall, LTFU was high in both groups. Latecomers to clinical visits were more at risk of both death and LTFU. Therefore, this should be a warning to clinical teams and preventive actions taken in these patients. Trial registration: ClinicalTrials.gov identifier: NCT03249493.. [ABSTRACT FROM AUTHOR]

To evaluate the efficacy of environment-based intervention on participation outcomes and parent efficacy in autistic children. Twenty-one autistic children 6–10 years old and their parents were randomized to environment-based intervention (n = 11) or usual care (n = 10). The environment-based intervention targets individualized participation goals in leisure and community activities through changing environment and activity demands. The study outcomes were Canadian Occupational Performance Measure (COPM), Goal attainment scaling (GAS), and Parent Empowerment and Efficacy Measure (PEEM). Assessments included baseline, 12 weeks (post-test), and 24 weeks (follow-up). Mixed ANOVAs were used to examine within-group and between-group effects in outcome variables. The COPM performance and satisfaction scores and GAS T-scores increased after environment-based intervention from baseline to 12 weeks and 24 weeks (p < 0.001) but did not significantly differ from usual care. The medium to large effect sizes of COPM performance and GAS T-scores favored the environment-based intervention. For the PEEM scores, no significant differences were found. Environment-based intervention may support school-age autistic children to participate in self-chosen activities over time. The intervention effects on participation goals and parent efficacy, however, were inconclusive and need further research. Environmental barriers are important attributes to participation restriction in autistic children. Interventions focusing on modifying the task and environment is viable in supporting the participation of autistic children. The environment-based intervention appears to improve the participation goals in leisure and community-based activities over time. The environment-focused strategies may include providing social support, enabling access to a sensory-friendly environment, finding inclusive programs, adapting task demands, and managing routines. [ABSTRACT FROM AUTHOR]

To evaluate the immediate and 4-week effects of compression garments (CG) on balance using a force platform during 8 different visual, static, and dynamic conditions in hypermobile Ehlers-Danlos Syndrome (hEDS) patients. Thirty-six participants were randomly assigned to a group: physiotherapy alone (PT, n = 19) or physiotherapy and daily CG wearing for 4 weeks (PT + CG, n = 17). Both attended 12 physiotherapy sessions (strengthening, proprioception, and balance exercises) for 4 weeks. Primary outcome: sway velocity of the centre of pressure (COP) measured before, immediately with the CG, and at 4 weeks. Secondary outcomes: ellipse area, Romberg quotient, and pain. Sway velocity in dynamic conditions decreased immediately with the CG. After 4 weeks of intervention, sway velocity (95% CI 4.36–39.23, effect size 0.93) and area (95% CI 146–3274, effect size 0.45) on the laterally oscillating platform with eyes-closed improved more in the PT + CG group than the PT group. Romberg quotient on foam cushion improved more in the PT + CG than the PT group. Pain decreased in both groups after 4 weeks with no between-group difference. CG combined with physiotherapy improved dynamic balance measured with COP variables significantly more than physiotherapy alone in people with hEDS. NCT03359135 Compression garments immediately improve balance in people with hypermobile Ehlers-Danlos Syndrome (hEDS) Compression garments combined with regular physiotherapy improve balance in people with hEDS after 4 weeks of treatment Compression garments could compensate for proprioceptive impairment in hEDS [ABSTRACT FROM AUTHOR]

Good rehabilitation adherence leads to effective post-stroke recovery. However, some recovering patients experience post-stroke depressive symptoms, which can affect post-stroke health outcomes. Previous studies have not examined the effect of a combination of rehabilitation adherence and depressive symptoms on recovery after a stroke. This study explored the combined predictive influence of rehabilitation adherence and post-stroke depressive symptoms on self-care abilities and quality of life in patients with stroke. This prospective longitudinal study analyzed data from 75 stroke patients. We examined rehabilitation adherence (self-reported, five-point scale), post-stroke depressive symptoms (Taiwanese Depression Scale), self-care ability (Chinese versions of the Barthel Index and Lawton – Brody Instrumental Activities of Daily Living Scale), and post-stroke quality of life (World Health Organization Quality of Life-BREF). Patients were followed up for six months after inclusion. The influence of rehabilitation adherence and post-stroke depressive symptoms on post-stroke self-care abilities and quality of life was examined using generalized estimating equations. The sample's mean age was 60.85 (±12.9) years. Patients with perfect rehabilitation adherence had better self-care abilities and quality of life than those with imperfect rehabilitation adherence. Patients without post-stroke depressive symptoms had a better quality of life than their counterparts. Patients with perfect rehabilitation adherence and no post-stroke depressive symptoms had better self-care abilities and quality of life than those with imperfect rehabilitation adherence and post-stroke depressive symptoms. Both depressive symptoms and rehabilitation adherence behavior impacted the rehabilitation effect among patients who are recovering from a stroke. [ABSTRACT FROM AUTHOR]

Shock after resuscitation from out-of-hospital cardiac arrest (OHCA) is often treated with vasopressors. We examined whether infusion of epinephrine versus norepinephrine was associated with prehospital rearrest and neurologically favorable survival among OHCA patients. This retrospective study included OHCA cases in Seattle, Washington from 2014-2021 who had return of spontaneous circulation (ROSC) followed by vasopressor infusion. Our primary exposure was infusion of epinephrine or norepinephrine. Our primary outcome was prehospital rearrest. Secondary outcomes included survival and neurologically favorable outcome (Cerebral Performance Category score of 1 or 2). We used multivariable logistic regression to test associations between exposures and outcomes adjusting for key covariates. Of 451 OHCA patients with ROSC followed by vasopressor infusion, 253 (56%) received norepinephrine and 198 (44%) received epinephrine infusions. Those who received epinephrine were older (median 66 [interquartile ranges {IQR} 53-79] vs 63 [IQR 47-75] years), but otherwise had similar baseline characteristics. Patients who received epinephrine were twice as likely to rearrest (55% vs 25%). After adjustment, the difference in rearrest rates between epinephrine and norepinephrine persisted (OR 3.28, 95%CI 2.25-5.08), and the odds of pulses at hospital arrival were lower in the epinephrine group (OR 0.52 95%CI 0.32-0.83). After adjustment, there was no difference in neurologically favorable survival, survival to hospital admission, or survival to discharge. Patients who received epinephrine infusions after ROSC suffered prehospital rearrest more frequently than those who received norepinephrine. Survival and neurological status at hospital discharge were similar. Future trials should examine the optimal approach to hemodynamic management for post-OHCA shock. [ABSTRACT FROM AUTHOR]

Prehospital traumatic cardiac arrest (TCA) is associated with a poor prognosis and requires urgent interventions to address its potentially reversible causes. Resuscitative efforts of TCA in the prehospital setting may entail significant resource allocation and impose added tolls on caregivers. The Israel Defense Forces Medical Corps (IDF-MC) instructs clinicians to perform a set protocol in the case of TCA, providing prompt oxygenation, chest decompression and volume resuscitation. This study investigates the settings, interventions, and outcomes of TCA resuscitation by IDF-MC teams over 25 years in both combat and civilian settings. Retrospective study of the IDF-MC Trauma Registry between 1997–2022. Search criteria were applied to identify cases where the TCA protocol was initiated. A manual review of cases matching the search criteria was performed by two curators to determine the indications, interventions, and outcomes of casualties with prehospital TCA. Patients for whom interventions were performed outside of the TCA protocol, such as with measurable vital signs, were excluded. The primary outcome was survival to hospital admission, with the secondary outcome being return of vital signs in the prehospital setting. Following case review, 149 patients with prehospital TCA were included, with a median age of 21 (interquartile range 19–27). Eighty-four (56.4%) presented with TCA in military or combat settings, with gunshot wounds and blast injuries being the most common mechanisms in this group. For 56 casualties (37.8%), all components of the protocol were performed (oxygenation, chest decompression, and volume resuscitation). Five (3.4%) casualties had return of vital signs in the prehospital setting, but none survived to hospital admission. The prognosis of prehospital TCA is poor, and efforts to address its potentially reversible causes may often be futile. These notions may be further emphasized in military settings, where resources are limited, and extensive penetrating injuries are more common. [ABSTRACT FROM AUTHOR]

We sought to describe prehospital ultrasound (PHUS) use and trends in PHUS utilization over time using a national database. Using the 2018 – 2021 National Emergency Medical Services Information System databases, we identified those EMS activations where PHUS was performed. We evaluated the association between year and number of PHUS exams performed using univariable and multivariable regression analysis. Analysis was performed on the overall group and various subgroups. In total, there were 148,709,000 EMS activations by 13,899 agencies over the 4 years. Of these, 3,291 unique activations (0.002%) involved PHUS, performed by 71 EMS agencies (0.5%). The annual rate of ultrasound evaluations per 1 million EMS activations significantly increased over the study period: 5.2 in 2018, 14.8 in 2019, 18.6 in 2020, and 38.9 in 2021 (p < 0.01). The number of agencies performing PHUS each year increased over the study period from 11 in 2018 to 54 in 2021 (p < 0.05). Each year after 2018 had an increased odds of PHUS use demonstrated with logistic regression (p < 0.01). PHUS was used in each US census region, and paramedics performed most of the PHUS exams (75.5%). We identified 1,060 out-of-hospital cardiac arrest, 820 trauma, and 427 respiratory PHUS cases. These three cohorts accounted for 70.1% of all PHUS cases. Prehospital ultrasound use in the United States increased significantly over the study period, but remains exceedingly rare. The performance of PHUS was recorded throughout the United States, with paramedics performing the majority of PHUS studies included in this database. [ABSTRACT FROM AUTHOR]

The aim is to pilot a low-touch program for reducing benzodiazepine receptor agonist (BZRA; benzodiazepines, z-drugs) prescriptions among older veterans. Pilot randomized controlled trial consists of 2,009 veterans aged ≥ 65 years who received BZRA prescriptions from a Veterans Health Administration pharmacy (Colorado or Montana) during the prior 18 months. Active: Arm 1 was a mailed brochure about BZRA risks that also included information about a free, online cognitive behavioral therapy for the insomnia (CBTI) program. Arm 2 was a mailed brochure (same as arm 1) and telephone reinforcement call. Control: Arm 3 was a mailed brochure without insomnia treatment information. Active BZRA prescriptions at follow-up (6 and 12 months) were measured. In logistic regression analyses, the odds of BZRA prescription at 6- and 12-month follow-ups were not significantly different for arm 1 or 2 (active) versus arm 3 (control), including models adjusted for demographics and prescription characteristics (p-values >0.36). Although we observed no differences in active BZRA prescriptions, this pilot study provides guidance for conducting a future study, indicating a need for a more potent intervention. A full-scale trial testing an optimized program would provide conclusive results. Mailing information about BZRA risks and CBTI did not affect BZRA prescriptions. [ABSTRACT FROM AUTHOR]

This study aimed to determine the prevalence of dizziness and its associated factors in patients with COM at two otologic referral centres in a middle-income country. Cross-sectional study. Adults with and without COM diagnosis from two otology-referral centres in Bogotá (Colombia) were included. Dizziness and quality of life were assessed using the "Chronic Suppurative Otitis Media Questionnaire-12" (COMQ-12), and sociodemographic questionnaires were applied. Otoscopic evaluation and audiometric data were collected. A total of 231 adults. Of the 231 participants, up to 64.5% (n = 149) reported at least mild inconvenience due to dizziness. Factors associated with dizziness included female sex (aPR: 1.23; 95% CI: 1.04–1.46), chronic suppurative otitis media (aPR: 3.02; 95% CI: 1.21–7.52), and severe tinnitus (aPR: 1.75; 95% CI: 1.24–2.48). An interaction was found between socioeconomic status and educational level, with more frequent reports of dizziness in the middle/high economic status and secondary education (aPR: 3.09; 95% CI: 0.52–18.55; p < 0.001). Differences of 14 points in symptom severity and 18.5 points in the total score of the COMQ-12 were found between the groups with dizziness and without dizziness. Dizziness was frequent in patients with COM and was associated with severe tinnitus and quality of life deterioration. [ABSTRACT FROM AUTHOR]

Exercise protects against somatic comorbidities and positively affects cognitive function and psychiatric symptoms in patients with severe mental illness. In forensic psychiatry, exercise is a novel concept. Staff at inpatient care facilities may be important resources for successful intervention. Little is known about staff's knowledge, attitudes and behaviors regarding exercise in forensic psychiatric care. To translate, culturally adapt and test the feasibility of the Exercise in Mental Health Questionnaire-Health Professionals Version (EMIQ-HP) in the Swedish context, and to use this EMIQ-HP-Swedish version to describe staff's knowledge, attitudes and behaviors regarding exercise. The EMIQ-HP was translated, culturally adapted, pilot-tested and thereafter used in a cross-sectional nationwide survey. Ten of 25 clinics and 239 health professionals (50.1%) participated. Two parts of the EMIQ-HP-Swedish version showed problems. Most participants considered exercise to be a low-risk treatment (92.4%) that is beneficial (99.2%). Training in exercise prescription was reported by 16.3%. Half of participants (52.7%) prescribed exercise and 50.0% of those undertook formal assessments prior to prescribing. Creation of the EMIQ-HP-Swedish version was successful, despite some clarity problems. Exercise appears to be prescribed informally by non-experts in Swedish forensic psychiatric care and does not address treatment goals. [ABSTRACT FROM AUTHOR]

This study aimed to analyze the posts published with the #preventivedentistry on Instagram. In this cross-sectional retrospective study, the #preventivedentistry was searched on Instagram. Data were collected between 01/10/2023 and 01/20/2023. A total of 940 posts were analyzed for type, purpose, and source. The number of likes of the posts and the number of video views were determined. Of the posts examined, 869 were images, and 71 were videos. Of the posts, 19.7% (n = 185) with the #preventivedentistry were about preventive dentistry. The content of 80.3% (n = 755) included advertisements, celebrations, information about other dental practices, patient satisfaction, and personal sharing. Among specialist dentists, pediatric dentists shared the most posts about preventive dentistry. Regardless of content, most of the posts had 0-25 likes, and only a small percentage had above 300 likes. People searching with #preventivedentistry on Instagram cannot find sufficient information about preventive dentistry. Dental professionals should use Instagram more actively to increase awareness of preventive dentistry. [ABSTRACT FROM AUTHOR]

To solicit information/suggestions from prostate cancer survivors to improve survivorship experiences specific to work/workability. The study employed a qualitative/phenomenological approach. Black/African-American and white prostate cancer survivors who: (1) had prostatectomy or radiation therapy 6–36 months prior, (2) were working for pay within 30 days before having treatment, and (3) expected to be working for pay 6 months later (n = 45) were eligible for this study. Survivors were engaged in 60-to-90-minute structured interviews. Content analysis was used to ascertain prominent themes. Participants had the following recommendations for survivors: ask about research on treatment options and side effects; speak with other survivors about cancer diagnosis; and inform family/friends and employers about needed accommodations. Considerations for family/friends emphasized the significance of instrumental (e.g. help finding information) and emotional support (e.g. encouragement). Employer/co-worker considerations most often related to work-related accommodations/support and avoiding stigmatization of the survivor. Considerations for healthcare providers commonly included the provision of unbiased, plain-language communication about treatment options and side effects. No major differences existed by race. Needs of employed PrCA survivors, regardless of their race or treatment type, are commonly related to their desire for informational, instrumental, and/or emotional support from family/friends, employers/co-workers, and healthcare providers. The requested supports are most often related to the side effects of prostate cancer treatment. [ABSTRACT FROM AUTHOR]